文章摘要
王鑫,祁乐,王露.局部脑氧饱和度监测对老年高血压脊柱内固定手术围术期循环和炎症因子的影响.骨科,2023,14(4): 358-362.
局部脑氧饱和度监测对老年高血压脊柱内固定手术围术期循环和炎症因子的影响
Effect of Regional Cerebral Oxygen Saturation Monitoring on Perioperative Circulation and Inflammatory Factors in Elderly Hypertensive Patients Undergoing Spinal Fixation Surgery
投稿时间:2022-10-17  
DOI:10.3969/j.issn.1674-8573.2023.04.012
中文关键词: 局部脑氧饱和度  老年  高血压  骨科手术  全身麻醉  血压管理
英文关键词: Regional cerebral oxygen saturation  Aged  Hypertension  Orthopedic surgery  General anesthesia  Blood pressure
基金项目:国家自然科学基金项目(82071903)
作者单位E-mail
王鑫 江苏省徐州市中心医院麻醉科江苏徐州 221009  
祁乐 江苏省徐州市中心医院麻醉科江苏徐州 221009  
王露 江苏省徐州市中心医院麻醉科江苏徐州 221009 13407531129@163.com 
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中文摘要:
      目的 探讨局部脑氧饱和度(rSO2)监测在高血压老年病人脊柱内固定手术中对围术期循环、炎症因子水平以及病人术后认知功能的影响。方法 选取我院2020年1月至2021年1月老年高血压骨科全麻手术病人106例,随机抽签分为观察组与对照组,观察组术中持续监测rSO2,对照组仅行常规管理。观察两组麻醉前(T0)、手术开始时(T1)、手术开始30 min(T2)、手术开始90 min(T3)及术后(T4)的rSO2、平均动脉血压(MAP)及心率变化,比较两组手术前、术后3 d神经生长因子(NGF)、前列腺素E2(PGE2)、神经肽Y(NPY)、白介素6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平、术后神经认知功能障碍(PND)及躁动发生率。结果 观察组手术时间、出血量、术后引流量明显低于对照组(P<0.05)。T1、T2、T3时观察组rSO2明显高于对照组(P<0.05);T2、T3时观察组MAP明显高于对照组(P<0.05)。与术前比较,两组术后3 d NGF、PGE2、NPY、IL-6、CRP、TNF-α水平均明显升高(P<0.05),但术后3 d观察组IL-6、CRP、TNF-α水平明显低于对照组(P<0.05)。两组PND及躁动发生率比较,差异无统计学意义(P>0.05)。结论 rSO2监测指导高血压老年病人脊柱内固定手术的血压管理效果可靠,可减少术中出血量并降低术后炎性因子水平。
英文摘要:
      Objective To investigate the effect of regional cerebral oxygen saturation (rSO2) monitoring on perioperative circulation, inflammatory factors and postoperative cognitive function in elderly hypertensive patients undergoing spinal fixation surgery. Methods A total of 106 elderly patients with hypertension undergoing spinal fixation surgery under the general anesthesia were enrolled in our hospital from January 2020 to January 2021. Patients were randomly divided into observation group and control group. Observation group received continuous intraoperative monitoring of rSO2, and control group received routine management only. Perioperative indexes of the two groups were recorded, and changes of rSO2, mean arterial blood pressure (MAP) and heart rate were observed before anesthesia (T0), at the beginning of surgery (T1), 30 min at the beginning of surgery (T2), 90 min at the beginning of surgery (T3) and after surgery (T4). The two groups were compared before operation and 3 days after operation: the levels of nerve growth factor (NGF), prostaglandin E2 (PGE2), neuropeptide Y (NPY), interleukin 6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and the incidence of postoperative neurocognitive dysfunction (PND) and agitation. Results The operation time, bleeding volume and postoperative flow rate in the observation group were significantly reduced as compared with those in the control group (P<0.05). The rSO2 in the observation group was significantly higher than that in the control group at T1, T2 and T3 (P<0.05). At T2 and T3, the MAP in the observation group was significantly higher than that in the control group (P<0.05). The levels of NGF, PGE2 and NPY were significantly higher in the two groups 3 days after operation than those before operation (P<0.05). The levels of IL-6, CRP and TNF-α were significantly higher in the two groups 3 days after operation than those before operation (P<0.05). At 3rd day after operation, the levels of IL-6, CRP and TNF-α in the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in the incidence of PND and agitation between the two groups (P>0.05). Conclusion rSO2 monitoring is reliable in guiding the blood pressure management of spinal internal fixation in elderly hypertensive patients, which can reduce intraoperative blood loss and postoperative inflammatory factors.
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